1. Field of the Invention
The present invention generally relates to the field of medicine, in particular to diagnostics and surgery. In the diagnostic and surgery domain surgical instruments, apparatus, or methods are used under the application of endoscopy to examine internal parts of living organisms and/or to perform operative interventions.
2. Related Art
Surgical instruments for endoscopy are sufficiently known. Endoscopic instruments, for instance, also find application in laparoscopic surgery, whereby, with the help of an optical instrument, interventions are undertaken within the abdominal cavity, in particular in minimal invasive surgery. In this case, trocars are introduced into the patient's body through small openings. The endoscopic instruments for imaging and/or flexible gripping devices or cutting tools are finally passed through the openings to facilitate extraction of tissue samples (biopsies). Other surgical instruments also can be inserted in the cavity through the trocar opening. In this manner, for instance, a dorsal or a ventral access to the spinal column can also be created in order to be able to perform a minimal invasive intervention with the help of the surgical instruments. To do this, for instance, just to mention some, a work element, bone curette, pestle, cutting tool, or an exploring tenaculum can be introduced at the distal end of the instrument shaft.
During the operation, whilst the trocar is in place, different endoscopic instruments that carry a special work element find application respectively. To operate the work element located at the distal end of the instruments shaft, the endoscopic instrument contains an operating element at the proximal end of the instruments shaft. The operating element decisively influences the handling of the surgery instrument.
After the operation on the patient, the utilised surgical instruments are contaminated by body fluids and must be cleaned. Most surgical instruments can be dismantled into their unit so components for a cleaning process, during which the internal parts of the tubular instrument shaft pose a big challenge. To dismantle the surgery instrument, the tension and/or compression element is movably guided in the tubular element that is operated at the distal end of a working means and is provided with and is detachable from a coupling element at the proximal end, which is connected with the movable operating element that can be pulled out of the instrument shaft. On the one hand, the coupling point is therefore meant for the transmission of the tension and compression forces from the operating rod of the operating element onto the tension and compression element in the tubular instrument shaft, and on the other hand regarding easy handling, whereby separation of the instrument shaft from the operating element is of special importance.
The invention therefore relates to a medical instrument, in particular a surgical instrument, for to the application in minimal invasive surgery, with a tubular element, work element and an operating element that is detachably located at the proximal end of the tubular element and furthermore with a tension and compression element displaceably guided inside the tubular element, of which the front end operates a work element and the rear end is detachably connected with the movable operating element via a coupling element.
Such medical instruments, in particular surgical instruments, in different designs and embodiments have proven functionality in the endoscopy, in particular in laparoscopy, whereby examinations and minimal invasive application on the patient have multiply proven itself. The operating elements of such surgical instruments are therefore of special importance.
As known from the state of the art, the operating element for surgical instruments of diverse grip designs, for instance the so-called pistol grip, comprise a two-ring grip that is similar to that of a pair of scissors or an axial grip in which the grips are mostly fitted with a locking element.
An example of an operating element with a scissors grip can be derived from DE 20121753 U1. The operating element consists of a grip with two grip parts that move against one another and a detachable latch that locks the grip parts in their respective position, in which the latch features a sliding member attached to one of the grip parts, which is axially slide-able in another clamping housing, mounted on the other grip part and that the sliding member, through a spring-loaded clamping element in the clamping housing, can be clamped against sliding and that the clamping element is movable against the spring force from its clamping position.
The embodiment of such an operating element is shown in several operation cases where endoscopic surgery is so large in outer dimensions and too cumbersome and the operating angle, i.e. the position of the angular operating element relative to the instrument shaft is inconvenient in handling. The latch locking element consists of numerous single parts which are likewise relatively large and bulky. Furthermore, the depicted operating element with a connected instrument shaft is not suitable for cleaning the said due to the absence of a flushing connection. The above mentioned details concern the surgical instruments with their gripping parts as disclosed in DE 298 04 860 U1 and DE 697 24 040 T2, in which the grip parts do not contain detachable latches.
For this reason, DE 10 2004 009 200 A1 proposes a surgical instrument for cleaning the instrument shaft, which is formed with a round rod shaft for endoscopic application in pistol-type design with an operating grip for a jaw-type mechanism on the instrument shaft, the operating rod on the grip side is detachable from the rigid shaft rod and designed capable of tilting out for the purpose of cleaning. The disadvantage of this embodiment is that the instrument shaft must is be dismantled for cleaning and coupling in and out of the instrument shaft with the operating element, which is tedious.
Further surgical instruments with a pistol-type grip that find application in the endoscopic surgery are apparent in DE 695 28 416 T2 and DE 10 2004 031 928 A1. Also here the grip parts are not equipped with cleaning connections that facilitate the instrument shaft cleaning. Moreover, locking elements or detachable latches are missing on the movable grips.
The laparoscopy forceps disclosed in DE 10 2004 025 041 A1 is seen as the nearest state of the art for surgery instruments with a pistol-type grip as an operating element. The laparoscopy instrument is connected with a fixed grip with the gripping piece that is movable via a link. On the fixed grip piece is a connection nipple for the connection with a hose for supplying the cleaning medium. The disadvantage of this embodiment is that the operating element is relatively large and does not have a detachable latch for the gripping pieces and that the coupling element is formed out of a plurality of single parts. Likewise, the operating angle, i.e. the position of the angular operating element relative to the instrument shaft has a disadvantageous effect in the handling the surgery instrument in several operating application cases. Furthermore, swiveling the movable branches on the grip part can result in a negative movement of the organ to be operated; this applies to all large handgrip embodiments.
DE 91 14 674.7 is mentioned as a representative of many surgical instruments with axial operating elements or handgrips that do not possess any suitable coupling point for receiving different instrument shafts although they have a detachable latch for handgrips. The instrument cannot be dismantled for cleaning purposes and does not possess a connection on the handgrip, for cleaning liquids.
Another embodiment of a surgical instrument with an axial grip and a locking knob may be derived from EP 0 820 725 B1. This instrument does not contain any coupling point and cannot therefore be dismantled between the instrument shaft and the operating element. A connection for cleaning liquids is also missing on the axial grip.
For the surgical instruments with an axial grip, EP 0 327 410 B1 shows an instrument that is used as a multifunction instrument in the laparoscopy, the possibility of dismantling exists between the shaft and the operating element. Dismantling can occur via a bayonet connection between the cannula and the handgrip, in that a special connection piece is available on the cannula, which features a flushing-line connection. The handgrip is operated electrically for different functions using numerous control means. This special embodiment has different disadvantages. The most significant disadvantage is that the handgrip of the instrument is not compatible with other instrument shafts and the connection of an electrical line on the handgrip makes the handling of the instrument difficult for the surgery.